IAAB #RejectHate Incident Form
If you have witnessed or experienced bullying or harassment, please complete the form below. By doing so, you help ensure that we have an understanding of the occurrence and impact of hate, as well as how we can address it as an organization and community.
Your First Name *
Your answer
Your Last Name
Your answer
Your Email *
Your answer
Date Incident Occurred *
MM
/
DD
/
YYYY
Where did this incident occur? *
Location of Incident (include city and state)
Your answer
Please describe the incident. *
Your answer
What was your role in the incident? *
Your answer
What was the role of bystanders, if any? *
Your answer
Did you report this incident? If so, to whom? *
Your answer
Age (optional)
Gender (optional)
Sexual Orientation (optional)
Race or Ethnic Identity (optional)
How may we support you? *
Your answer
Anything else you'd like to share?
Your answer
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